Manual lymphatic drainage reduces tissue sodium and self-reported pain in women with lipedema: a quantitative MRI study.
5 affiliations
- 1Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn, Bonn, Germany.
- 2Institute for Basic Lymphological Research, LY.SEARCH gGmbH, Düsseldorf, Germany.
- 3Department of Anesthesiology and Intensive Care Medicine, Translational Pain Research, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany.
- 4TheraNova, Centre for Physical Therapy, Cologne, Germany.
- 5Department of Anesthesiology and Intensive Care Medicine, Pain Center, University Hospital of Cologne, University of Cologne, Cologne, Germany.
Abstract
Background
Lipedema is a chronic adipose tissue disorder characterized by a disproportionate accumulation of painful subcutaneous fat on the extremities. Manual lymphatic drainage (MLD) is routinely used as therapeutic intervention, but its immediate physiological effects remain unclear. We evaluated the immediate impact of MLD on tissue composition in Lipedema using multiparametric Magnetic-resonance-imaging (MRI).Materials and methods
Fifteen women with Lipedema (5 women each for stages I/II/III; median age 43.7 [20.4-68.8] years), thirteen with lower-limb lymphedema (3/5/5 women for stages I/II/III; median age 57.6 [18.6-70.4] years) underwent quantitative MRI of the legs including volumetry, sodium MRI, proton-densitiy fat-fraction (PDFF), T1, T2 and fat-suppressed T2 mapping before and after a standardized 1 h MLD session. Five normal controls (median age 41.9 [23.3-66.2] years) were examined only before MLD. Regions of interest in skin, subcutaneous adipose tissue (SAT), and muscle were analyzed. Pain was assessed by numeric rating scale (NRS). Wilcoxon tests and Spearman correlations were applied to test for differences pre- and post-MLD as well as for associations between measurements and clinical parameters (p < 0.05).Results
At baseline, women with Lipedema showed higher tissue sodium and water-sensitive MRI measures compared to controls (skin sodium: median 17.7 vs. 12.3 mmol/L, p < 0.001; skin T2: 56 vs. 37 ms, p = 0.03), though lower than lymphedema (skin sodium: 32.1 mmol/L, skin T2: 70 ms). Tissue sodium in women with Lipedema correlated with clinical stage (r = 0.775, p = 0.001) and pain intensity (r = 0.656, p = 0.01). After MLD, perceived pain intensity decreased (median NRS 2 → 0, p = 0.007) and edema-related MRI metrics including tissue sodium decreased in women with Lipedema (skin sodium: 17.7 → 14.8 mmol/L, p = 0.001; skin T2: 56 → 43 ms, p = 0.001). Parameter changes in the same direction after MLD were detected in women with Lymphedema (skin sodium: 32.1 → 27.1 mmol/L, p = 0.001; skin T2: 70 → 61 ms, p = 0.001).Conclusion
Manual lymphatic drainage produces immediate, quantifiable changes in treated tissue in women with lipedema, indicating mobilization of sodium-rich interstitial fluid.
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BibTeX
@article{noll2026manual,
title = {{Manual lymphatic drainage reduces tissue sodium and self-reported pain in women with lipedema: a quantitative MRI study.}},
author = {E Nöll and A Henkel and M E Cornely and R Dinnendahl and E Breuer and S Nowak and T Hucho and J A Luetkens and C C Pieper},
journal = {Frontiers in cell and developmental biology},
year = {2026},
month = oct,
doi = {10.3389/fcell.2026.1808579},
url = {https://europepmc.org/article/MED/42909292},
note = {CC BY},
}
RIS
TY - JOUR
TI - Manual lymphatic drainage reduces tissue sodium and self-reported pain in women with lipedema: a quantitative MRI study.
AU - E Nöll
AU - A Henkel
AU - M E Cornely
AU - R Dinnendahl
AU - E Breuer
AU - S Nowak
AU - T Hucho
AU - J A Luetkens
AU - C C Pieper
PY - 2026
DA - 2026/10/07
JO - Frontiers in cell and developmental biology
DO - 10.3389/fcell.2026.1808579
UR - https://europepmc.org/article/MED/42909292
AB - Background Lipedema is a chronic adipose tissue disorder characterized by a disproportionate accumulation of painful subcutaneous fat on the extremities. Manual lymphatic drainage (MLD) is routinely used as therapeutic intervention, but its immediate physiological effects remain unclear. We evaluated the immediate impact of MLD on tissue composition in Lipedema using multiparametric Magnetic-resonance-imaging (MRI).Materials and methods Fifteen women with Lipedema (5 women each for stages I/II/III; median age 43.7 [20.4-68.8] years), thirteen with lower-limb lymphedema (3/5/5 women for stages I/II/III; median age 57.6 [18.6-70.4] years) underwent quantitative MRI of the legs including volumetry, sodium MRI, proton-densitiy fat-fraction (PDFF), T1, T2 and fat-suppressed T2 mapping before and after a standardized 1 h MLD session. Five normal controls (median age 41.9 [23.3-66.2] years) were examined only before MLD. Regions of interest in skin, subcutaneous adipose tissue (SAT), and muscle were analyzed. Pain was assessed by numeric rating scale (NRS). Wilcoxon tests and Spearman correlations were applied to test for differences pre- and post-MLD as well as for associations between measurements and clinical parameters (p < 0.05).Results At baseline, women with Lipedema showed higher tissue sodium and water-sensitive MRI measures compared to controls (skin sodium: median 17.7 vs. 12.3 mmol/L, p < 0.001; skin T2: 56 vs. 37 ms, p = 0.03), though lower than lymphedema (skin sodium: 32.1 mmol/L, skin T2: 70 ms). Tissue sodium in women with Lipedema correlated with clinical stage (r = 0.775, p = 0.001) and pain intensity (r = 0.656, p = 0.01). After MLD, perceived pain intensity decreased (median NRS 2 → 0, p = 0.007) and edema-related MRI metrics including tissue sodium decreased in women with Lipedema (skin sodium: 17.7 → 14.8 mmol/L, p = 0.001; skin T2: 56 → 43 ms, p = 0.001). Parameter changes in the same direction after MLD were detected in women with Lymphedema (skin sodium: 32.1 → 27.1 mmol/L, p = 0.001; skin T2: 70 → 61 ms, p = 0.001).Conclusion Manual lymphatic drainage produces immediate, quantifiable changes in treated tissue in women with lipedema, indicating mobilization of sodium-rich interstitial fluid.
SN - 2296-634X
ER -